Medical Credentialing Specialist

Job Description

Job Description

JOB TITLE: Credentialing Specialist

REPORTS TO: Revenue Cycle Manager 

FLSA STATUS:  Non-Exempt  

QUALIFICATIONS/EDUCATION:

• AA Degree required.
• Minimum two years of experience in healthcare credentialing.
• Knowledge of regulatory requirements and accreditation standards for provider credentialing.
• Proficient in MS Office and intermediate in Excel, Word, and Outlook.
• Experience in using credentialing software and databases.
• Strong attention to detail and ability to maintain accurate records.
• Excellent organizational and time management skills.
• Effective communication skills, both written and verbal.

SUPERVISORY RESPONSIBILITIES: 

N/A 

ESSENTIAL DUTIES/ RESPONSIBILITIES: 

• Completes provider applications/reapplications.
• Responds to requests from insurance companies for information/documentation.
• Follow up with insurance companies and hospitals regarding the status of physician applications.
• Notifies insurance carriers when a physician joins or leaves the practice.
• Tracks the above information to promote the speed of processing.
• Processes change of addresses for each practitioner/practice location.
• Manages renewals (medical licenses, DEA's, occupational licenses) for all providers.
• Maintains Availity, NPI, and CAQH databases and quarterly re-attestation.
• Obtain Hospital Privileges for providers and re-credentialing.
• Maintains a current and accurate contract listing, identifying the credentialing status of all physicians for the plan and updating the SharePoint site information.
• Responds to requests from insurance companies for information/documentation.
• Conduct primary source verification of credentials and qualifications.
• Verify and validate provider information, including licensure, certifications, and education.
• Assists Marketing in identifying all insurance plans by physicians. Updates the Insurance Plans via the FMC internet for each provider.
• Maintains a resource file on each practitioner electronically, which includes copies of current licenses/CME/ DEA/malpractice/Board certifications/plan participation/ Hospital privilege information.
• Follow up with insurance companies and hospitals regarding the status of physician applications.
• Assist in process improvement of the credentialing process.
• collaborate with internal teams to resolve credentialing issues or discrepancies.
• Performs other related duties as required and assigned.

Qualified individuals, please submit your resume.

We offer a competitive salary; Employee Health Insurance is covered at 100%. We also offer Dental, Vision, Life, and 401k Benefits.